Given the task definition and input, reply with output. In this task, you are given a text of many news articles seperated by special token "|||||". Your task is to summarize them.

It’s an annual ritual for millions of American women: Visiting the doctor and lying back for a routine pelvic exam, feet in stirrups. Now the nation’s largest largest medical specialty organization says that tradition needs to change. 
  
 A new guideline published Monday from the American College of Physicians says doctors should not do pelvic exams on non-pregnant adult women with no symptoms of disease. A review of the exams found they rarely catch disease but are costly, uncomfortable and even embarrassing. 
  
 “It is a fairly straightforward, simple guideline,” says Dr. Linda Humphrey, co-author of the guidelines published in Annals of Internal Medicine and a professor of medicine, public health and preventive medicine at Oregon Health & Science University in Portland. And it is based on a “very strong” review of nearly 70 years of medical studies, she says. 
  
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 The guideline does not apply to Pap smear screening for cervical cancer, which should be done every three to five years, depending on a woman’s age. And it’s sure to be controversial — the American College of Obstetricians and Gynecologists remains in favor of an annual exam. American College of Physicians members are internists, specialists in the care of adults. 
  
 “There just wasn’t evidence that [routine pelvic examination] was beneficial,” says Humphrey. The review found that pelvic exams rarely detected ovarian cancer or bacterial infection and did not reduce mortality. Yet they add $2.6 billion in “unnecessary costs to the health care system,” according to the journal article. 
  
 The review also found potential harms, although the evidence was weak. These harms include embarrassment, fear, anxiety, pain and discomfort. Those were “magnified in women who had a history of sexual trauma, post-traumatic stress disorder or in overweight women,” says Humphrey. 
  
 Other potential harms include women avoiding health care visits because they dislike the exam and doctors finding abnormalities that don’t matter but that may lead to additional and invasive testing. 
  
 In a typical pelvic exam, the doctor examines external genitalia, inserts an instrument called a speculum into the vagina to examine the vagina and cervix, and then places a hand on the abdomen and the other inside the vagina to feel for abnormalities. 
  
 The new guideline recommends a pelvic exam only for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction. And it says cervical cancer screening should be limited to visual inspection of the cervix and swabbing the cervix for cancer and human papillomavirus; manual examination is not necessary. 
  
 Dr. Humphrey said nixing the pelvic exam doesn’t mean that women should not have an annual well visit. 
  
 “ If it starts a conversation between a woman and her physician or provider, I think that is terrific and as it should be.” 
  
 The American College of Obstetricians and Gynecologists agrees that there is no data showing that routine pelvic exams save lives or do a good job of detecting ovarian cancer or infection. But routine pelvic exams do have value, it says. Its guideline, published in 2012, continues to recommend exams and encourages women to discuss whether to have one with their health care provider. If a woman doesn’t want the exam, she should still have an annual check-up. 
  
 “It is the experience of the members of our practice committee and our executive board and those of us who created this guideline that, indeed, women coming to see us who are ‘asymptomatic’ often have issues that they want to discuss but don’t raise them with us initially,” says Dr. Barbara Levy, the group’s vice president for health policy. “The pelvic examination creates an opportunity for us to raise those issues with a patient if we see something on the exam.” 
  
 For example, a woman might be too embarrassed to talk about incontinence, but “the position of the urethra” — the tube from the bladder to the outside — “relative to other tissues can raise a red flag for a clinician that indicates, ‘I should ask her about whether she is leaking urine,’” says Levy. 
  
 Or an ob-gyn might observe during a pelvic examination that the muscles of the pelvic floor are extremely tight and don’t relax. “In my experience, that is frequently a woman who has an experience of sexual abuse of some kind, and she almost for sure is having sexual dysfunction but may be reluctant to discuss the issue unless I raise it with her,” says Levy. 
  
 Both Levy and Humphrey agree that women may come away from the different guidelines somewhat confused. “But if it starts a conversation between a woman and her physician or provider, I think that is terrific and as it should be,” says Levy. 
  
 Humphrey says confusion will change with time, as younger internists and ob-gyns more comfortable with evidence-based medicine dispense with the routine pelvic examination. 
  
 “Most family practitioners are already practicing this way, skipping the pelvic exam,” says Dr. Ranit Mishori, an associate professor of family medicine at Georgetown University. Now she would like to see gynecologists do the same. 
  
 But Levy doubts that most ob-gyns are going to drop the routine pelvic exam, nor should they, she says. “When women have these underlying issue that they’re hoping a physician will find and talk about, they’ll typically choose to see a gynecologist rather than an internist,” Levy says. |||||  
  
 Annals of Internal Medicine 
  
 The nation's second-largest physicians' organization said Monday that healthy women who are not pregnant do not need routine pelvic exams, a controversial recommendation based on its analysis that, on balance, the manual screening does more harm than good. 
  
 The American College of Physicians, which represents 137,000 internal medicine physicians and related specialists, said the diagnostic procedure causes some women discomfort, anxiety, pain and additional medical costs, and may keep some from seeing their doctors. Yet it does little to detect ovarian cancer or other disorders. 
  
 As a result, in a new guideline it issued Monday, the organization "recommends against performing screening pelvic examination in asymptomatic, non-pregnant, adult women" who have no elevated risk of cancer or other disease. Healthy women should continue to have Pap smears as recommended by their doctors, the group said. The guideline was published in the Annals of Internal Medicine, the ACP’s journal. 
  
 "The benefit hasn't been demonstrated, but the harm has," said Linda Humphrey, a professor of medicine at Oregon Health Sciences University, who helped write the new guidelines. "So when you look at the benefit-harm ratio, the harm kind of weighs out more than the benefits." 
  
 The American College of Obstetricians and Gynecologists, however, immediately responded in favor of doctors' continuing to perform routine pelvic screening on healthy women. That group "continues to firmly believe in the clinical value of pelvic examinations," it said in a statement, which help gynecologists turn up incontinence and sexual dysfunction, and allow them "to explain a patient's anatomy, reassure her of normalcy and answer her specific questions." 
  
 Barbara Levy, vice president for health policy at the organization, said that the pelvic exam provides a critical opportunity for women to raise concerns that, by themselves, might not send them in search of medical advice. "The pelvic exam, in our experience and in the opinion of our experts, has value," she said. " We see that value in being able recognize some of these embarrassing and sensitive issues that women often will not raise with us initially." 
  
 On its Web site, the National Ovarian Cancer Coalition recommends that "women age 18 and above should have a mandatory annual vaginal exam." But it also notes that "in most cases, ovarian cancer is not detected during routine pelvic exams, unless the doctor notes that the ovary is enlarged." 
  
 Humphrey said her group undertook a review of research on pelvic exams after the U.S. Preventive Services Task Force issued guidelines on screening for cervical cancer in 2012 but did not address pelvic exams. The review found that in two studies the "positive predictive value" of pelvic exams for ovarian cancer was less than 4 percent, and that 11 percent to 60 percent of women complained of pain or discomfort from the procedure. In one study, 174 abnormal screenings occurred among 2,000 healthy, average-risk women. Follow-up tests resulted in 31 surgeries, which found ovarian cancer in just two of the women. 
  
 Levy said, however, that those surgeries likely removed other abnormalities, such as fibroids and cysts, that could have caused problems later. 
  
 In the new guidelines, the American College of Physicians estimated the annual cost of preventive screenings, lab tests and radiologic services at $2.6 billion, a figure that Humphrey said could be reduced along with a substantial decline in routine pelvic exams. The document notes that a blood test is more sensitive at detecting ovarian cancer, though Levy said that test, known as "CA-125," is very imprecise. ||||| Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday. 
  
 There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors. 
  
 The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant. 
  
 “The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.” 
  
 The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams. 
  
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 A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the bimanual examination, in which the physician inserts two gloved fingers into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes. 
  
 The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs. 
  
 The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams were not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and that they may be particularly traumatic for women who have been sexually assaulted. 
  
 The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts. 
  
 Until about a decade ago, physicians routinely performed pelvic exams before prescribing oral contraceptives, and they used the exams to screen women for sexually transmitted infections and obtain cultures for testing. Those practices have largely been abandoned, and urine samples are now used to test for sexually transmitted infections. 
  
 In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether. 
  
 Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction. 
  
 “Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara S. Levy, vice president for health policy at the obstetricians and gynecologists’ group. 
  
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 “I’m not sure there’s evidence to support most of what we do on physical exams,” Dr. Levy added. “Lack of evidence does not mean lack of value.” 
  
 The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular. 
  
 In 2009, the United States Preventive Services Task Force recommended postponing routine mammograms to detect breast cancer until age 50, provoking wide controversy. Many women have ignored the advice. 
  
 More recently, the task force, the American Cancer Society and the obstetricians and gynecologists’ group have recommended that, with some exceptions, women ages 21 to 65 should receive Pap smears every three years instead of annually. |||||

Are the pelvic exams that make up part of routine physicals for women actually necessary? The country's second-biggest doctors' group says no, arguing that there is no evidence that the exams are useful—while there are many reports of the exams causing women anxiety, pain, and discomfort. The exam, which generally requires a woman to place her feet in stirrups while a speculum is inserted into her vagina "has become a yearly ritual," a former president of the American College of Physicians tells the New York Times, but "a lot of women dread it." The college's new guidelines suggest doctors stop performing the exams as part of physicals for healthy women. A co-author of the new guidelines say they are based on a "very strong" review of nearly 70 years of medical studies, reports NBC. The review found that the exams rarely spot ovarian cancer, add $2.6 billion in "unnecessary costs to the health care system," and the fear or embarrassment some feel during the exam is "magnified in women who had a history of sexual trauma, post-traumatic stress disorder, or in overweight women." But the American College of Obstetricians and Gynecologists disagrees with the new guidelines and says it firmly believes in their clinical value, the Washington Post finds. A spokeswoman for the group says the exams help doctors "recognize some of these embarrassing and sensitive issues that women often will not raise with us initially."